The Centers for Medicare and Medicaid Services (CMS) June 29 announced the physician groups selected to participate in the Oncology Care Model (OCM). CMS selected 17 health insurance companies and nearly 200 physician group practices that includes more than 3,200 oncologists. The model will cover approximately 155,000 Medicare beneficiaries nationwide.
Physician group practices that participate in the five-year program are required to provide enhanced services to beneficiaries to help them receive timely, coordinated treatment. Some examples of enhanced services include: coordinating appointments to ensure timely delivery of diagnostic and treatment services, providing 24/7 access to care when needed, and arranging follow-up appointments with key stakeholders.
OCM includes nearly all cancer types. OCM episodes will be triggered by the administration of chemotherapy. Furthermore, the OCM episode will include all Medicare Part A and B, and certain Part D services that fee-for-service (FFS) beneficiaries receive during the episode period.
OCM aims to improve the quality and reduce the cost of cancer care through a two-part payment approach. First, CMS will provide OCM participants with a per-beneficiary, per-month payment of $160 that can be used to fund CMS-required practice improvements. Second, OCM utilizes a retrospective reconciliation process under which participants are eligible to receive a portion of their savings if they achieve specific quality and cost thresholds.
While the first two years of the program include upside risk only, practices may elect to adopt a two-sided risk model in year three. Practicing in the two-sided risk track of the OCM will qualify as an Advanced Alternative Payment Model participant for the newly proposed Quality Payment Program under the Medicare Access and CHIP Reauthorization Act.